International Health Review (IHR)

Volume 2 Issue 2, Fall 2022

ISSN(P): 2791-0008, ISSN(E): 2791-0016
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Article QR

Association of Cerebral Palsy (CP) Child Behavior with Caregiver

Title: Stress Level

Author (s): Muhammad Asim Raza1, Hira Jabeen2, Atiq Ijaz3, Binash Afzal2, Sara Mumtaz4
1
Mukhatar A. Sheikh WELFARE hospital Multan, Pakistan
Affiliation (s): 2
Riphah International University, Pakistan
3
Ahmed Medical complex, Kasur, Pakistan
4
Avicenna Medical College and Hospital, Pakistan
DOI: http://doi.org/10.32350/ihr.22.01

Received: June 4, 2022, Revised: September 25, 2022, Accepted: September 26, 2022,
History: Published: December 15, 2022
Raza MA, Jabeen H, Ijaz A, Afzal B, Mumtaz S. Association of cerebral palsy
Citation:
(CP) child behavior with caregiver stress level. Int health Rev. 2022;2(2):1–9.
http://doi.org/10.32350/ihr.22.01

Copyright: © The Authors

Licensing: This article is open access and is distributed under the terms of
Creative Commons Attribution 4.0 International License
Conflict of
Interest: Author(s) declared no conflict of interest

A publication of
The School of Science
University of Management and Technology, Lahore, Pakistan
Association of Cerebral Palsy (CP) Child Behavior with
Caregiver Stress Level
Hafiz Muhammad Asim Raza1, Hira Jabeen2, Atiq Ijaz3, Binash Afzal2, and Sara
Mumtaz4*
1
Mukhatar A. Sheikh WELFARE hospital Multan, Pakistan
2
Riphah International University, Pakistan
3
Ahmed Medical complex, Kasur, Pakistan
4
Avicenna Medical College and Hospital, Pakistan
Abstract
The disability which occurs frequently in children is known as cerebral
palsy (CP). Its prevalence in Pakistan is much higher and about 2 to 3 out
of every 1000 children are diagnosed with CP, which affects their functional
status of life to a greater extent. The objective of the current study was to
determine the association of CP child's behavior with caregiver's stress
level. The current study was based on a cross sectional design and it
comprised 159 caregivers of CP child. Among them 100 were males and 59
were females. The study was conducted within the time period from
December 2016 to May 2017. A convenience sampling technique was used
and subjects were selected from different hospitals and rehabilitation
centers of Lahore, Pakistan on the basis of inclusion and exclusion criteria
after taking informed consent. The two standardized “parental stress scale”
and “strength difficulty questionnaire” helped to determine the level of
stress and caregiver' burden. The data was analyzed using SPSS v20. The
frequency was calculated to obtain mean values of caregiver stress and
behavior of CP child using PSS and SDQ. P value ≤ .05 was considered
statistically significant. The Pearson correlation (r) between PSS and SDQ
data was r₌ 0.63, which showed a strong positive linear correlation between
the two variables, that is, CP child behavior & caregiver stress level. It
indicated that both variables increased or decreased together. The behavior
of CP child affects the quality of life of parents and caregivers. The study
concluded that there is a strong relationship between the CP child's
behavior with the caregiver’s stress level.
Keywords: cerebral palsy (CP), CP child behavior, health status, Parental
Stress Scale (PSS), Strength Difficulty Questionnaire (SDQ)

*
Corresponding Author: Samz.mars23@gmail.com
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Introduction
In childhood, the most frequent disability disorder that occurs among
children is cerebral palsy (CP), in which motor impairments occur due to
lesion in brain during early development [1–3].
This disorder of movement abnormalities in posture causes activity
constraint, credited to the no progressive disturbances that occur during
development of child’s brain. In CP, patients with motor abnormality are
often accompanied by the disturbance of communication, behavioral
disorder, sensation, perception, and cognition [4–6].
The occurrence of CP ranges from 1.4 to 4 per 1000 live births. Mother, as
the primary caregiver of CP child, is afflicted with more depression and
stress as compared to other mothers of normal children [7–9].
Giving care to the children with motor functional limitation is the basic right
of being parents. One of the major challenges that caregivers face include
managing their child’s medical issues along with their requirements of daily
living at home [10–12].
The family issues in CP child include financial burdens, such as, out of
pocket cost and members who are unemployed. It also affects their health
and daily activities, for instance jobs and they need additional income for
medical and personal expenses of CP child [2, 3, 14].
It is a difficult task for caregivers to accomplish physical and psychological
emotional demands of CP patients. Moreover, it also changes the social life
of caregivers. The caregivers face financial, physical, psychological, and
emotional stressors. It may be due to low quality of care [15, 16].
The caregivers of CP child often experience behavioral difficulties and
limitation in functional skills. The basic idea of the current study was to
discover the relation between aspects of parental distress in the parental task
due to CP child behavioral issues [17, 18].
The perception of the caregiver or parents of CP child is related to factors,
such as, occupation, education, and number of children resources. All these
mentioned factors play an important role to develop perception related to
CP child’s care [19, 20].
A descriptive study was conducted in physical medicine and rehabilitation
department in New Delhi, India. The data from 65 caregivers of CP patients
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was collected through questionnaires pertaining to physical and mental

health from family burden scale. For data analysis, multiple regressions and
descriptive statistics were also used. At the end of study, it was determined
that both mental and physical health were affected. Moreover, their three
domains, such as, 1) family activities, 2) family leisure, and 3) family
interaction were also found to be disrupted in caregivers of CP patients [21,
22].
Another cross sectional study was conducted in which data was collected
from 424 Irani mothers of CP patients. The association of quality of life was
assessed in primary caregivers. The data was collected from different
rehabilitation centers. The results showed that the caregiver of CP patients,
especially mothers suffer from poor physical and mental health [23, 24].
Another cross sectional study was conducted in which data was collected
through (SSDS), a tool to identify the mother depression from Neurology
OPD, Karachi, and Rehabilitation Centre DUHS Karachi. The data was
collected from 81 mothers of the CP children. Out of 40 primary caregiver
(mothers) with depression, 30% got mild depression, 60% moderate, and
10% severe depression [7].
Material and Methods
The current study was based on a cross sectional design. Physical therapy
department of Children’s hospital, Gulab Devi hospital Lahore, PSRD, and
Social Security hospital Ferozepur road, Lahore were the places from which
data was collected. Caregivers of CP children were the source of data
collection. This study was completed in three months after the approval of
synopsis. The non-probability convenient sampling technique was used.
The sample size was 196 after calculation from “Rao soft”. Caregivers, for
instance, mothers, fathers or any other relation who spend minimum 6 to 1
hours with CP child were included in this study. Caregivers with diagnosed
chronic illness and caregivers who were not willing to participate were
excluded from this study. The data was collected from caregivers of CP
children after getting consent from ethical review board committee of the
related organization. The parent or caregiver of CP children gave the
informed consent. The data collection tools included PSS and SDQ Scale.
The questionnaire was fully elaborated and explained by the researcher to
CP child parents and caregivers. SPSS version 20 was used to analyze the
data.

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Results
Table 1. Descriptive Statistics of Age
Minimum Maximum Mean ±SD
Age 4 13 6.51±2.56
Out of 159 sample, mean age of the CP child was 6.51(2.56)
Table 2. Frequencies

Gender Frequency (n=159) Percentage

Male 100 62.9
Female 59 37.1
Out of sample 159, male 100 (frequency, 100 percent, 62.9) and female 59
(frequency 59 percent 37.1) of CP child.
Table 3. Correlation of Parental Stress and Behavior of child / (Strength
difficulty questionnaire)
R P –value
Parental stress scale and .631 .000
Strength difficulty scale
.631 .000
A strong positive significant correlation was found between parental stress
scale and strength difficulties questionnaire, because (P value .000, r value
.631).
Discussion
In childhood the most frequent disability disorder is cerebral palsy in which
motor impairments occur due to lesion in brain during early development
[1]. The purpose of the current research was to determine the association of
CP child with caregiver stress level. In order to determine the effects of
CP child behavior with the health status of his/her caregivers, such as,
mother, father or any other relation, it is necessary to spend a minimum of
6 to 10 hours or less than half a day with the CP child.
By coping with the behavioral issues of CP children, caregiver stress could
be reduced, which help them having better social life and job status of the
caregiver.

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The psychological changes of CP child cause mental and physical stress in

their caregivers. The previous studies focused on the behavior of CP
caregivers and distress, however, this study would determine the association
of CP child behavior on caregivers’ health status.
The results of the current study proved the alternate hypothesis that there
are significant effects on the parental health status due to CP child behavior.
The results of other studies supported this statement.
A previous study in 2004 was designed to compare the health of caregivers
of CP children with other general population caregivers on the basis of
physical and psychological health status.
It was proved that the caregivers of CP children had less income as
compared to other general population of caregivers [25]. This study also
showed the same results that the CP child tends to impose a financial burden
for caregivers. Another descriptive study was conducted in New Delhi,
India 2016, in which both mental and physical health were found to be
affected and their three domains for instance, family activities, family
leisure, and family interaction were also found to be disrupted in caregivers
of CP patients [21]. This study also showed the 4 domains of SDQ which
somewhat affected the caregiver health status.
A recent study was found to be differing from other similar studies because
of the use of observation tools and amount of study population.
The existing significant findings showed that the health of the parents is
much affected by the behavior of their CP child. The parents face many
problems regarding their child and it made them guilty that their stress
reason was due to their child.
Conclusion
CP child behavior affects the parent and caregiver’s quality of life. The
study concluded that there is a strong relationship between the CP child's
behaviors with the caregiver’s stress level. Therefore, it could be said that
the parent's life gets much affected due to their CP child's behavior.
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